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DETECTION
OF EARLY BREAST CANCER
Symptoms
of early breast cancer and clinical examination.
Most
women are aware that the presence of a breast lump may indicate cancer,
however there are other important signs which may be particularly important
in detection of early impalpable breast cancer. It is important for the
patient and clinician to be aware of any recent unilateral changes shown
in "Watch for new
changes".
Change
in sensation
may be in the form any odd feeling, discomfort or pain in one breast particularly
if it is new and persistent. An important point to consider is an ill
fitting bra where pressure from a bra edge, seam, or bone can cause symptoms.
Majority of these patients have outer quadrant tenderness where there
is maximum amount of glandular tissue. Unilateral symptoms if new and
persistent must be investigated completely especially in patients above
the age of 35 years.
| Nipple
change
may be in the form of either discharge or as moist reddish areas.
Any discharge which is new and not milky must be investigated. Bleeding
from nipple has several causes and when it occurs after 35 years of
age cancer must be excluded with mammography, ultrasonography and
cytology. It is extremely common to confuse a dark stain on bra due
to duct stagnation with blood. Either cytology or patent test for
blood, e.g. occult test, haemostix can easily provide confirmation.
Moist reddish areas which do not heal easily must be completely investigated
to rule out Paget's disease including cytology from nipple scrapings
and mammography. An important point worth remembering is that even
Paget's disease may heal temporarily with steroid ointments. |
Paget's
disease of the nipple |
Visible
change :
any difference between the appearance of the two breasts, especially those
produced by arm elevation. With proper inspection in different position
of arms may reveal an evanescent change which is produced by muscle contraction
and can be associated with non-palpable very early cancer.
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Bilateral
symmetrical dimpling on muscle contraction. Patient was diagnosed
to have bilateral lobular carcinomate.
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Patient
at rest - No abnormality seen
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Contraction
of muscles demonstrating elevation of left Nipple-areolar complex.
Patient was diagnosed to have retro areolar cancer.
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Shows
dimpling on elevation of arms
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Mammogram
of same showing a small cancer
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| Palpable
change
may be in the form of lumps, thickening, nodularity or abnormal feel
in a localised area is extremely important if recently noticed. Palpation
may be carried out in many ways. It is indeed important to check all
areas systematically including axillary tail. The breast should be
arranged in thinnest possible layers and feeling with pulps of fingers
rather than finger tips or the palm of the hand. The smallest cancers
may be palpable only as thickened areas or nodularities. |
Position
of patient for an examintaion of difficult breast |
If
you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020
8565 5885
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